Ohio Health Care Fraud Lawyer
Health insurance and government health programs are expensive for providers and insurers. Whether a private company, state government, or the federal government is reimbursing health care providers for services, they are keenly aware of costs and profit. They are hyper-vigilant regarding who uses the insurance or health care program, like Medicare or Medicaid, and when. If the payor notices something is wrong with their invoices and reimbursements, they will investigate to determine if health care fraud is the cause. Medicaid fraud and Medicare fraud are all too common, and states and the federal government are concerned with finding and prosecuting the perpetrators.
If you are accused of committing health care fraud, you may face criminal charges. You should contact an Ohio health care fraud lawyer as soon as possible to discuss your legal rights and options. You can reach our experienced fraud defense lawyers at Luftman, Heck & Associates by calling (513) 338-1890 or through our online form.
Ohio Health Care Fraud Law
Medicaid is a joint health care program between the federal government and each state. The purpose of Medicaid is to ensure certain low-income individuals and people with disabilities can receive medical services. As of 2017, Medicaid provides health insurance to approximately 74 million people in the U.S. Medicaid is not the same as Medicare, which is a federal health insurance program for individuals who are 65 years and older and certain younger individuals with disabilities.
Under Ohio Revised Code (ORC) 2913.40(B), it is illegal to knowingly make, or cause to be made, a false or misleading statement or misrepresentation for use in obtaining reimbursement from Medicaid.
Under ORC 2913.40(C), it is illegal for you, with the purpose to commit or facilitate fraud, to:
- Charge, solicit, accept, or receive any payment for goods or services you provide under the Medicaid program that would be in addition to the amount of the Medicaid reimbursement; or
- Solicit, offer, or receive any remuneration, such as a kickback or rebate, in connection with providing goods or services that are fully or partially reimbursed under Medicaid.
Additionally, ORC 2913.40(D) states it is illegal to knowingly alter, falsify, destroy, conceal, or remove any records that are necessary to fully disclose:
- The nature of goods or services for which a claim to Medicaid was submitted; or
- All income and expenditures upon which rates of reimbursements were based.
At Luftman, Heck & Associate, we understand Ohio’s laws regarding health care fraud can be confusing when insurance and other health care programs are complicated enough. We also know that many innocent mistakes lead to accusations of health care fraud for individuals, medical providers, and health care workers. If you are accused of committing health care fraud against Medicaid, contact a Cincinnati health care fraud attorney immediately.
Examples of Medicaid Fraud
Some of the most common types of Medicaid fraud include:
- Billing for medically unnecessary products or services;
- Billing for products or services that were not actually provided;
- Billing separately or multiple times for the same product or service;
- Billing generic drugs as more expensive than they actually are;
- Writing prescriptions for unnecessary compound drugs;
- Writing or altering prescriptions to obtain drugs for personal use or unlawful sale;
- Providing false information on cost reports;
- Overcharging co-pays;
- Providing discounts for services in exchange for Medicaid reimbursement;
- Providing products or services and claiming reimbursement for someone other than the beneficiary;
- Not providing service to eligible recipients; and
- Billing for an ineligible beneficiary.
For many of these examples, state and federal authorities investigate health care providers and industry workers. As a physician, dentist, pharmacist, nurse, or other health care worker, you have to be careful to adhere to the many laws and regulations regarding Medicaid and Medicare to avoid accidentally breaking the law. If Ohio or the federal government notices something off with your reimbursements, you could become the focus of a health care fraud investigation and health care fraud charges.
However, if you are a beneficiary of Medicaid, you could also be charged for a fraudulent medical claim or other type of health care fraud. You could be accused of:
- Sharing your Medicaid ID card with someone else for them to unlawfully obtain medical services;
- Altering or duplicating a Medicaid ID card;
- Helping your physical file a false claim by undergoing tests and procedures you do not need;
- Altering a physician’s prescription;
- Going to multiple physicians to obtain the same drug or types of drugs;
- Selling prescription drugs to others;
- Accepting cash payment or other valuable property from a physician in exchange for referring beneficiaries to that physician’s practice; or
- Providing inaccurate information to qualify for Medicaid.
Whether you are a health care professional or Medicaid beneficiary, if you are accused of fraud, you need to call an Ohio health care fraud lawyer right away.
Ohio Penalties for Medicaid Fraud
In many situations, Medicaid fraud is a first-degree misdemeanor. You could be sentenced to a maximum of 180 days in jail or house arrest, probation, and fines up to $1,000.
However, the value of the services or funds you obtained in the course of your unlawful conduct matters. The greater the value you unlawfully obtained, the higher the charge.
- If the value of the goods and services illegally obtained in your case is between $1,000 and $7,500, you will face a fifth-degree felony. You face between 6 and 12 months in prison and fines reaching $2,500.
- If the value of the goods and services illegally obtained in your case is between $7,500 and $150,000, you will face a fourth-degree felony. You may be imprisoned for between 6 and 18 months and fines up to $5,000.
- If the value of the goods and services illegally obtained in your case is more than $150,000, you will face a third-degree felony. You can be penalized with between 9 months and 5 years’ imprisonment and a maximum fine of $10,000.
Contact an Ohio Health Care Fraud Lawyer
Considering the potentially severe consequences of a criminal health care fraud conviction, you need to contact a health care defense attorney as soon as possible. There may be a number of defenses available in your case, including that you lacked the intent to commit a crime. Our team at Luftman, Heck & Associates will review every aspect of your case and gather evidence on your behalf. We will build you the strongest defense possible and fight for the best possible outcome in your case. While our goal will be to exonerate you in court, we will also prepare to mitigate the consequences of a conviction.